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Actually, that would be the beginning, not the end, of an interesting story - the story of how you came to the point of forming such an idiotic, over-generalized conclusion. You have posted more than once about the prestige of the medical profession, as if that is a tremendous sore point with you. Do you have basic insecurities and a feeling of lack or prestige yourself that you would begrudge an entire profession its prestige? Did some doctor once cause you very deep humiliation which gave rise to such irrational hatred? What is your job or profession? Suppose you are a plumber, and suppose I said, "Plumbers are scum, end of story"? That wouldn't make a bit of sense, and neither does your statement. Do you hate any other large group of people, or just doctors? There is a lot more to this story. (Just for the record, I am not a doctor nor did I ever work in the health field in any capacity).

lol.. I would dismiss it as an unfounded and illogical standpoint and move one, I have other things to worry about/care about.

By the by, i don't hate any group. I generally don't like people who do.

I'm not saying it's unwarranted that some patients deserve to be despised.

But at the same time when the lame doctor who feels "challenged" by a patient with strange/undefined symptoms, or a patient who is actually medically knowledgeable (for example, another doctor), then they probably need to rethink their own actions when they react with hatred. For example, this one doctor who almost killed me with a botched procedure reacted very poorly afterwards and blamed me as soon as I was extubated from my emergency surgery. LOL. That's cuz she KNOWS that if she had only listened to my concerns, she wouldn't have to worry about a lawsuit. Of course I didn't sue her because I'm not that type of person and I understand that mistakes can be made. But it just goes to show how irrational even doctors can be when their ego is on the line.

Oh, the number of times I've heard physicians get annoyed at their physican-patients... even when the patient is making absolutely reasonable requests.

There are just two classes of doctors. Ones who think, and ones who don't. We are paying them to think.

I'm gonna rep Marylee for actually knowing what I'm talking about! Of course she has experienced what I am talking about firsthand ... I seriously wish that nobody has to go through uncertainty and abandonment when they have an atypical diagnosis.

I'm just plain not buying the malarchy about the penicillin. No licensed MD in the USA will assume that no rash/hives = no allergy to penicillin. That's absolutely ridiculous. A penicillin allergy -can- be life-threatening and no REAL doctor would make that assumption.

However...

Just because you have a reaction, doesn't mean you're allergic. There are many possible adverse reactions (side effects) to taking penicillin. I'm pretty confident that there's a lot of this story missing, or misinterpreted, or just made up for dramatic effect.

No one can have this much trouble with doctors, unless they've found someone completely incompetent and refuse to see anyone else.

Would it not be better to say, "When I took penicillin, my skin turned blue. I looked like a Smurf. I would prefer not to take it again. What would you recommend instead?" This expresses your concern in a nonthreatening way, and your doctor would likely agree with your request. Why is it so hard to be honest and up front and just describe the effect the drug had that bothers you?

Because when I did tell doctors the reaction I had to penicillin, they discounted it, mainly because it didn't fit their little checklist.

I've had 2 relatives with similar reactions to penicillin. Why should I risk taking it again when there's so many other antibiotics out there?

And yes, in my opinion, I'm allergic to penicillin. Why bother to ask me my allergies, then dispute them? Do I have to prove it over and over, or why can't they just take my word for it? I've had docotrs literally insist I could "probably take penicillin again with no consequences" simply because it didn't fit into their little checklist. Hey, it threatens me to be told I'm about to be given a drug I've had problems in the past, regardless of whether you call it an allergy, reaction, or whatever.

The point I was trying to make is not whether I'm allergic to penicillin, but how doctors just can't function outside the box. If it doesn't fit their little checklist, they're lost.

The point I was making is that you are misusing the medical term "allergy". What "reaction" did you and your family members have?

An "allergy" is an immune response to a substance that most people find totally innocuous.. It can be as simple as a rash or hives or you can have full blown anaphylaxis with extensive swelling, difficulty breathing, and possible death. Asthma and hay fever are allergies. So is eczema. Allergies are associated with very specific changes in physiology.

I still do not understand why you have to insist that whatever symptoms you had when you took penicillin are an "allergy" when you have been told they are not.

The problem is not that your doctors cannot think outside the box. The problem is you keep trying to put something in the allergy box that doesn't fit there.

The point I was making is that you are misusing the medical term "allergy". What "reaction" did you and your family members have?

An "allergy" is an immune response to a substance that most people find totally innocuous.. It can be as simple as a rash or hives or you can have full blown anaphylaxis with extensive swelling, difficulty breathing, and possible death. Asthma and hay fever are allergies. So is eczema. Allergies are associated with very specific changes in physiology.

I still do not understand why you have to insist that whatever symptoms you had when you took penicillin are an "allergy" when you have been told they are not.

The problem is not that your doctors cannot think outside the box. The problem is you keep trying to put something in the allergy box that doesn't fit there.

How do you know its not an allergy? I had some of they symptoms, but not all of them. Aren't 3 out of 5 enough? Do I have to drop dead to prove the point? They can't figure out how to think if it doesn't fit their little checklist.

Would you take a drug again if you'd had a prior reaction to it? Regardless of what you call it, allergy, reaction, whatever, still, would you risk taking it again if you'd had a reaction to it before? And a family history? When I say reaction, they don't note it. If I say allergy, they do note it. See, the whole idea of going to doctors is not to get killed in the process of treatment!

Oh, BTW, our reactions were all the same---difficulty breathing, a feeling of tightness in the throat, nausea, and dizziness. The reactions not on the list were hives and itching. Ok, isn't that enough?

How do you know its not an allergy? I had some of they symptoms, but not all of them. Aren't 3 out of 5 enough? Do I have to drop dead to prove the point? They can't figure out how to think if it doesn't fit their little checklist.

Would you take a drug again if you'd had a prior reaction to it? Regardless of what you call it, allergy, reaction, whatever, still, would you risk taking it again if you'd had a reaction to it before? And a family history? When I say reaction, they don't note it. If I say allergy, they do note it. See, the whole idea of going to doctors is not to get killed in the process of treatment!

Oh, BTW, our reactions were all the same---difficulty breathing, a feeling of tightness in the throat, nausea, and dizziness. The reactions not on the list were hives and itching. Ok, isn't that enough?

Now see, that wasn't hard was it? Next question: were you on Prednisone when you took the penicillin? That could have modified the response and blocked the hives.

SuzyQ: I do understand the MCAT. I was on the admissions committee for 2 years. The test isn't easy, but neither is medicine. I would hate to be harsh... but we need to hold doctors to higher standards.

I am also familiar with the chart you posted. Does it not surprise you that 25% of people who got 26 and below got into med school? I don't think that high GPAs should offset low MCATs, whereas high MCATs can offset low GPA. This is because GPAs are largely dependent on the institution and difficulty of major (i.e. physics from MIT vs. Sociology from College X), whereas the MCATs are standardized.

Of course there are extenuating circumstances - like in your son's case - but does that make up 25% of applicants? I doubt it... As far as the ethnic gap, affirmative action had already been applied for entrance into university. The playing field should be even for disadvantaged ethnic groups.

I do understand "EBM" and "best practice guidelines" after having it crammed down my throat and having witnessed it misused time and again. They are things to follow 95% of the time, but these change constantly with new research. Some guidelines are engraved in stone, many are to be taken with grains of salt.

I actually don't care about bedside manners at all - only have a gripe for general incompetence and disinterest in the patient's problems. Disinterest is worse than bad bedside manners because it shows an unwillingness to do a job correctly... and academic disinterest. Having a mean doctor who gets the job done is much more preferable - in fact this was how things were done in the good old paternalistic days. By the way, Internal Medicine and Family Medicine are "specialties." Choice of specialty has more to do with a doctor's answer to "what do I want to be when I grow up" than ability. And most doctors do not "despise" their patients.

Not trying to diss any specialty, but FM and IM aren't in any way competitive and while some top students do end up there, most tend to go for subspecialties. That's just the sad truth.

And *most* doctors do despise *some* of their patients (not all) -- don't misquote me please. Can't tell you the number of times I've heard doctors badmouth their patients, rather than have an open confrontation.

I think your antagonistic attitude comes through in your interaction with your doctors. If you are unwilling to listen to them, why should they bother to send you home with anything except what you demand?

I know enough medicine to know what they are not doing optimally. Let's just leave it at that. They can absolutely refuse to do what I tell them to, but the reason they do not is because I demand things that are within reason. It's more of a collaboration - which is ideal. I know better than to antagonize my doctors.
There is a lot of science in medicine, but there is still a lot of art. Experience plays a big part --- the more you do it, the better you get.

I agree with that completely.

If you have vague, mysterious ailments that could be symptoms of hundreds of illnesses, you are not likely to get a diagnosis with a single office consultation. The best practices/evidence based medicine/checklists might save you (and your insurance company) a fortune in the process of discovering what is going on.

Again, this has to do with experience and doing what is right for the patient based on clinical information. I don't think EBM is always best for the patient. When there is a rare disease, how often are there guidelines for them? Almost never - because there aren't enough patients to do a large randomized clinical trial. So a good doc would be able to separate the zebras from the ordinary and know when to get aggressive. "See me in 3 months if symptoms persist"could potentially be fatal. PCP misses a DVT in a young postsurgical patient? Missed or delayed diagnosis for at least a year? Yes, it happens.

Of course the patient has to do their part and not go "doctor shopping". But I am sure it is hard when they are being given the runaround. The natural tendency is to do exactly that - doctor shopping and ED visits. A good doctor would schedule appropriate follow up and encourage the patient to be proactive in their own healthcare while continuing their workups.

And, you know what? Some symptoms end up having no satisfactory diagnosis to hang your hat on. At that point, the best your doctor can do is help you deal with the symptoms themselves.[/quote]

That is also true. Fibromyalgia and chronic fatigue are those diagnoses. But I can also tell you that many simple illnesses are missed because of dogma. My doc missed my asthma diagnosis for about 10 years because I never wheezed but always had shortness of breath. Got all sorts of anti-anxiety prescriptions, which I never took. Turns out it was small airways disease, finally diagnosed when I asked for PFTs -- straight up. Now I missed 10 years of inhaled steroid treatments and my lung function is at 60%. I don't blame the doctor for missing it because they were following guidelines. However, I do commend the doctor for listening to my request for a PFT. Unfortunately, I lost some lung function. But fortunately I get to save the rest of my lung function. I could literally write a book of missed diagnoses (all of them very common ailments.. nothing mysterious whatsoever, just took a bit of thinking to solve) that I've witnessed first hand. "Admit this patient for cellulitis!!! .... Oh wait... it's gout? Should have used my brain!"

That's why it's important for doctors to remain interested and invested in solving their patient's problems. I'd rather not defend the profession as it is, but be realistic about it so that it can be improved upon.

SuzyQ: I do understand the MCAT. I was on the admissions committee for 2 years. The test isn't easy, but neither is medicine. I would hate to be harsh... but we need to hold doctors to higher standards.

I am also familiar with the chart you posted. Does it not surprise you that 25% of people who got 26 and below got into med school? I don't think that high GPAs should offset low MCATs, whereas high MCATs can offset low GPA. This is because GPAs are largely dependent on the institution and difficulty of major (i.e. physics from MIT vs. Sociology from College X), whereas the MCATs are standardized.

Of course there are extenuating circumstances - like in your son's case - but does that make up 25% of applicants? I doubt it... As far as the ethnic gap, affirmative action had already been applied for entrance into university. The playing field should be even for disadvantaged ethnic groups.

I do understand "EBM" and "best practice guidelines" after having it crammed down my throat and having witnessed it misused time and again. They are things to follow 95% of the time, but these change constantly with new research. Some guidelines are engraved in stone, many are to be taken with grains of salt.

I actually don't care about bedside manners at all - only have a gripe for general incompetence and disinterest in the patient's problems. Disinterest is worse than bad bedside manners because it shows an unwillingness to do a job correctly... and academic disinterest. Having a mean doctor who gets the job done is much more preferable - in fact this was how things were done in the good old paternalistic days. By the way, Internal Medicine and Family Medicine are "specialties." Choice of specialty has more to do with a doctor's answer to "what do I want to be when I grow up" than ability. And most doctors do not "despise" their patients.

Not trying to diss any specialty, but FM and IM aren't in any way competitive and while some top students do end up there, most tend to go for subspecialties. That's just the sad truth.

And *most* doctors do despise *some* of their patients (not all) -- don't misquote me please. Can't tell you the number of times I've heard doctors badmouth their patients, rather than have an open confrontation.

I think your antagonistic attitude comes through in your interaction with your doctors. If you are unwilling to listen to them, why should they bother to send you home with anything except what you demand?

I know enough medicine to know what they are not doing optimally. Let's just leave it at that. They can absolutely refuse to do what I tell them to, but the reason they do not is because I demand things that are within reason. It's more of a collaboration - which is ideal. I know better than to antagonize my doctors.
There is a lot of science in medicine, but there is still a lot of art. Experience plays a big part --- the more you do it, the better you get.

I agree with that completely.

If you have vague, mysterious ailments that could be symptoms of hundreds of illnesses, you are not likely to get a diagnosis with a single office consultation. The best practices/evidence based medicine/checklists might save you (and your insurance company) a fortune in the process of discovering what is going on.

Again, this has to do with experience and doing what is right for the patient based on clinical information. I don't think EBM is always best for the patient. When there is a rare disease, how often are there guidelines for them? Almost never - because there aren't enough patients to do a large randomized clinical trial. So a good doc would be able to separate the zebras from the ordinary and know when to get aggressive. "See me in 3 months if symptoms persist"could potentially be fatal. PCP misses a DVT in a young postsurgical patient? Missed or delayed diagnosis for at least a year? Yes, it happens.

Of course the patient has to do their part and not go "doctor shopping". But I am sure it is hard when they are being given the runaround. The natural tendency is to do exactly that - doctor shopping and ED visits. A good doctor would schedule appropriate follow up and encourage the patient to be proactive in their own healthcare while continuing their workups.

And, you know what? Some symptoms end up having no satisfactory diagnosis to hang your hat on. At that point, the best your doctor can do is help you deal with the symptoms themselves.

That is also true. Fibromyalgia and chronic fatigue are those diagnoses. But I can also tell you that many simple illnesses are missed because of dogma. My doc missed my asthma diagnosis for about 10 years because I never wheezed but always had shortness of breath. Got all sorts of anti-anxiety prescriptions, which I never took. Turns out it was small airways disease, finally diagnosed when I asked for PFTs -- straight up. Now I missed 10 years of inhaled steroid treatments and my lung function is at 60%. I don't blame the doctor for missing it because they were following guidelines. However, I do commend the doctor for listening to my request for a PFT. Unfortunately, I lost some lung function. But fortunately I get to save the rest of my lung function. I could literally write a book of missed diagnoses (all of them very common ailments.. nothing mysterious whatsoever, just took a bit of thinking to solve) that I've witnessed first hand. "Admit this patient for cellulitis!!! .... Oh wait... it's gout? Should have used my brain!"

That's why it's important for doctors to remain interested and invested in solving their patient's problems. I'd rather not defend the profession as it is, but be realistic about it so that it can be improved upon.[/quote]

Thank you for expanding on your comments.

I am actually not surprised that people with MCATs below 26 get in. If they do, they must have something going for them that convinces the admissions committee to let them in --- and, no, I have never been on such a committee. I do know that the Medical College of Georgia did a study many years ago and concluded that the best predictor of success in medical school was the verbal score --- not the science scores. They concluded that if you had good language skills, you could be taught all the science you need to know. Are you familiar with this program?

I am not as pessimistic about the overall state of medicine in the USA as you are. I do know there are an awful lot of burned out docs who are hampered in taking care of patients by the demands of insurance companies to see more patients in less time. And some of the smartest, most capable docs I know are in primary care, one of whom diagnosed my Dad's "indigestion" as coronary artery disease and saved his life. I do regret seeing here on CD the comments from people who think ALL doctors are incompetent idiots. That is just not true.

Moreover, if what you are saying is true, why so many cases of poor doctors? Why doesn't society admit that the only real reason for the medical profession is prestige?

i think the answer lies in the process. the doctor comes in, asks you one question, and then you answer. then they ask a follow-up question. each question is based on the answer to the previous question. most patients don't volunteer information unless they are asked or it feels important. but patients aren't always the best judges of what's important -- sometimes small things that don't seem relevant are.

can you see how this process would easily lead to missing crucial information? i might be getting more nosebleeds than usual but since my doctor didn't ask that in their series of questions, i might not be inclined to mention that. but it could be the key to a diagnosis. by having this series of questions process, doctors end up with tunnel vision when it comes to diagnosing.

the other thing is they rely on the x out of y symptoms criteria. there are a lot of people that have 4 out of 10 symptoms, but for a diagnosis, 5 out of 10 is required. or a patient has all the symptoms except one, which is deemed crucial and more important than the others.

it's the process that leads to errors. doctors go from a to b to c to d without considering any parallel possibilities at each step. and once you've gone to the next step, you've missed your chance of catching any crucial information at the previous steps.

most of my doctors, despite messing up really badly, did seem sincere in their desire to practice medicine. the reason they messed up isn't cause they were seeking prestige, but because they weren't looking in the right places.

to follow up on what mary lee and suzy said, it took me forever to get a diagnosis of rheumatoid arthritis because i test negative for the rheumatoid factor, and because there is no single test that determines a fibromyalgia diagnosis. but i exhibited the symptoms clearly and consistently. but there are so many doctors that are test-result-focused that they completely forget about the validity of symptoms. i think more doctors need to take symptoms as seriously as they do tests. some doctors even have the mentality that if the tests don't back you up 100%, then your symptoms don't count. but symptoms aren't any less real. they should factor into a diagnosis just as much as test results do.

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